Note: Goldenseal is sometimes referred to as "Indian turmeric" or "curcuma," but it should not be confused with turmeric (Curcuma longa). Goldenseal contains berberine, an alkaloid constituent in goldenseal, so it is mentioned in this monograph, but a separate monograph is available on this topic.

Goldenseal is one of the five top-selling herbal products in the United States. However, there is little scientific evidence about its safety or effectiveness. Goldenseal may be found in dietary supplements, eardrops, feminine cleansing products, cold/flu remedies, allergy remedies, laxatives, and digestive aids.

Goldenseal is often found in combination with echinacea in treatments for upper respiratory infections and is suggested to enhance the effects of echinacea. However, the effects when these agents are combined are not scientifically proven.

Goldenseal has been used by some people due to the popular notion that detection of illegal drugs in urine may be hidden by use of the herb; however, scientific information is limited in this area. The popularity of goldenseal has led to a higher demand for the herb than growers can supply.

Studies on the effectiveness of goldenseal are limited to one of its main chemical ingredients, berberine salts. A small amount of berberine is actually present in most goldenseal preparations. Therefore, it is difficult to extend the research of berberine salts to the use of goldenseal. There is not enough scientific evidence to support the use of goldenseal in humans for any medical condition.

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

GRADE *

Limited research suggests that berberine, a chemical found in goldenseal, may be beneficial in the treatment of chloroquine-resistant malaria when used in combination with pyrimethamine. Due to the very small amount of berberine found in most goldenseal preparations, it is unclear whether goldenseal contains enough berberine to have these effects. More research is needed in this area.

C

Goldenseal has become a popular treatment for the common cold and upper respiratory tract infections, and is often added to echinacea in commercial herbal cold remedies. Berberine may have effects against bacteria and inflammation. However, due to the very small amount of berberine in most goldenseal preparations, it is unclear whether goldenseal contains enough berberine to have the same effects.

C

Early research suggests that berberine, in addition to a standard medication for chronic congestive heart failure (CHF), may improve quality of life, heart function, and mortality. Further research is needed to confirm these results.

C

Limited research suggests that berberine may lower cholesterol and triglycerides. Additional research is needed in this area.

C

Goldenseal is sometimes suggested to be an immune system stimulant. Further research is needed in this area.

C

Berberine has been used as a treatment for diarrhea caused by bacterial infections (including diarrhea from cholera). Due to the very small amount of berberine in most goldenseal products, it is unclear if goldenseal contains enough berberine to have the same effects. Additional studies are needed in this area.

C

It has been suggested that taking goldenseal may hide the presence of illegal drugs from urine tests. However, there is limited research to support this use.

C

The goldenseal component berberine may have effects against bacteria and inflammation. Early research suggests berberine may help treat trachoma. Further research is needed in this area.

C

Berberine, a chemical found in goldenseal, has been used in a combination product to treat burn wounds. Further research in this area using berberine alone is needed.

C

* Key to grades

A: Strong scientific evidence for this useB: Good scientific evidence for this useC: Unclear scientific evidence for this useD: Fair scientific evidence for this use (it may not work)F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Historically, goldenseal has been used in various formulations. The following doses have been used, each taken three times daily: 0.5-1 grams of goldenseal tablets or capsules; 0.3-1 milliliters of goldenseal liquid or fluid extract (1:1 in 60% ethanol); 2-4 milliliters of goldenseal alcoholic extract (1:10 in 60% ethanol); and 0.5-1 grams of dried goldenseal root as a tea.

To treat heart failure, 1.2-2 grams of berberine daily in divided doses has been taken by mouth for eight weeks. Additionally, 0.02 or 0.2 milligrams/kilogram/minute of berberine has been injected into the blood for 30 minutes.

To treat high cholesterol, 0.5 grams of berberine has been taken by mouth twice daily for three months.

To treat infectious diarrhea, 100-200 milligrams of berberine hydrochloride four times daily or a single dose of 400 milligrams has been taken by mouth. A dose of 50 milligrams of berberine hydrochloride has been taken every eight hours for two days, followed by 50 milligrams twice daily until the fifth day. Berberine sulfate is often used as well, and the hydrochloride and sulfate forms are generally considered interchangeable.

To treat narcotic concealment (urine analysis), four goldenseal capsules (535 milligrams each) (Nature's Herbs®, American Fork, UT) plus one gallon of water and one gallon of Naturally Klean Herbal Tea® (Klean Tea, AZ) have been taken by mouth.

To treat stimulation of the immune system in people with low white blood cell count, 50 milligrams of berberine has been taken by mouth three times daily for 1-4 weeks.

To treat trachoma (Chlamydia trachomatis eye infection), two drops of 0.2% berberine chloride solution have been used in each eye three times daily for three weeks.

Children (younger than 18 years)

To treat diarrhea, 25-50 milligrams of berberine has been taken by mouth four times daily.

To treat trachoma (Chlamydia trachomatis eye infection), a treatment consisting of 0.2% berberine eye drops has been used for three months.

Safety
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid in people with a known allergy or sensitivity to goldenseal (Hydrastis canadensis), any of its parts, including berberine and hydrastine, or to members of the Ranunculaceae family.

Side Effects and Warnings

Berberine is likely safe when used short-term in recommended doses.

Berberine may lower blood sugar levels. Caution is advised in people with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.

Goldenseal or berberine may increase the risk of bleeding. Caution is advised in people with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

Goldenseal or berberine may cause low blood pressure. Caution is advised in people taking drugs or herbs and supplements that lower blood pressure.

Drowsiness or sedation may occur. Use caution if driving or operating heavy machinery.

Use cautiously in people with heart disease or gastrointestinal disorders. Use cautiously in people taking agents that may alter immune function, agents that may increase sensitivity to the sun, and agents processed by the liver.

Avoid in pregnant women and children. Avoid in infants with increased bilirubin levels or people with glucose-6-phosphate deficiency.

Avoid in people with a known allergy or sensitivity to goldenseal (Hydrastis canadensis), any of its parts, including berberine and hydrastine, or to members of the Ranunculaceae family.

Adding other alkaloid-containing herbs to goldenseal, including Chinese goldthread (Coptis chinensis) and Oregon grape, may increase the risk of adverse events.

Goldenseal or its active component hydrastine taken by mouth may induce labor and should not be used by pregnant women. Berberine-containing herbs such as goldenseal have been suggested historically to induce abortion. Goldenseal preparations with Chinese goldthread (Coptis chinensis) were reportedly associated with multiple cases of brain damage from bilirubin in Asia in the 1970s and 1980s.

Goldenseal, at the prescribed human dose, is unlikely to be unsafe during pregnancy in humans, despite the apparent toxic effects in animal studies. However, additional studies are needed before a firm conclusion may be made.

Goldenseal has been used for sore nipples. A component of goldenseal, berberine, may cause brain damage in infants and may theoretically be present in breast milk due to its interaction with albumin.

Goldenseal is not recommended during breastfeeding, due to a lack of sufficient data.

Berberine may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

Goldenseal or its component berberine may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

Goldenseal may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be decreased in the blood, and reduce the intended effects. People taking any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.

Goldenseal may affect blood pressure. Caution is advised in people taking agents that lower blood pressure.

Goldenseal may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. Caution is advised while driving or operating machinery.

Berberine may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

Goldenseal or its component berberine may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

Goldenseal or its component berberine may interfere with the way the body processes certain herbs or supplements using the liver's "cytochrome P450" enzyme system. As a result, the levels of other herbs or supplements may become too high in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system.

Goldenseal may affect blood pressure. Caution is advised in people taking agents that lower blood pressure.

Goldenseal may increase the amount of drowsiness caused by some herbs or supplements.

Goldenseal or its component berberine may also interact with alkaloids; antibacterials; antihistamines; anti-inflammatory herbs and supplements; berberine-containing herbs and supplements; cholesterol lowering herbs and supplements; foxglove; herbs and supplements against fungi or helminths; herbs and supplements for abnormal heart rhythm; herbs and supplements for cancer, diarrhea, or malaria; herbs and supplements for the brain, heart, intestines and stomach; herbs and supplements that alter heart rate; herbs and supplements that may alter immune function; herbs and supplements that may increase sensitivity to the sun; herbs or supplements that may narrow blood vessels; herbs and supplements toxic to the liver; laxatives; marijuana; wound-healing herbs and supplements; yohimbe.

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.